Healthcare Provider Details

I. General information

NPI: 1457668667
Provider Name (Legal Business Name): ANDREW FEAZELLE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 W SUNSET BLVD
LOS ANGELES CA
90046-3304
US

IV. Provider business mailing address

5447 ZELZAH AVE APT 114
ENCINO CA
91316-2244
US

V. Phone/Fax

Practice location:
  • Phone: 323-876-4466
  • Fax:
Mailing address:
  • Phone: 818-344-2714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: